Enteroviral Meningitis in Neonates and Children of Mashhad, Iran

Abstract

BackgroundThe highest incidence of meningitis occurs during the neonatal period and (then) infancy. Although Bacterial agents are the most dangerous cause of neonatal and childhood meningitis yet viruses especially, enteroviruses (EV), are by far the most common cause of meningitis in this age group.ObjectivesThe aim of the current study was to evaluate the role of EVs in neonatal and childhood meningitis in the Mashhad city of Iran.Materials and MethodsThis was a descriptive study that was performed at Imam Reza hospital in a period of six months (March to September 2007), during which all of the cerebral spinal fluid (CSF) samples from the neonatal intensive care unit (NICU) and pediatrics ward were collected and real time-polymerase chain reaction (RT-PCR) for EVs was done on these samples. Clinical data were collected retrospectively from hospital files.ResultsWe collected 58 CSF samples (35 neonates and 23 children) during six months. Pleocytosis of CSF was seen in 51.1% of the subjects (28% of neonates, and 66.6% of infants and children). Enteroviruses PCR was positive in 37.1% (13) of neonates and 34.7% (8) of children. Pleocytosis of CSF was seen in 23% and 75% of EV positive neonates and children, respectively. Polymorphonuclear (PMN) dominance (PMN > 50%) of CSF was seen in 50% and 33% of EV positive neonates and children, respectively. There were three cases of bacterial meningitis in our group; EV PCR result was positive for one of these subjects. Concomitant bacterial infection (meningitis and sepsis) was seen in 9.5% (two cases) of EV positive CSFs in our study. Almost half of the available neonates (four of nine) with pure enteroviral meningitis (EVM) were discharged (in good condition) with final diagnosis of culture negative sepsis (CNS) and mean length of hospital stay (MLOS) of 4.3 days. One (12.5%) of the neonates with EVM, who had a very low birth weight (< 1500 mg), was expired, and two (25%) cases were discharged with brain damage and final diagnosis of severe asphyxia. The MLOS for children with pure EVM was 1.6 days (one to four days); they didn't have any sign of brain damage or mortality. Qualitative c-reactive protein (CRP) of serum was negative in 72.7% and 37.5% of EV positive neonates and children, respectively. The mean white blood cell count and PMN percentage in the peripheral blood was 11416/mm3 and 60.8% for EV positive neonates, and 14500/mm3 and 77.1% for EV positive children, respectively. Hyponatremia, due to possible syndrome of inappropriate antidiuretic hormone (SIADH), was seen in 30% of neonates and 57% of children with EVM.ConclusionsEnteroviruses were a common cause (> 30%) of meningitis in our study group. Concomitant bacterial infection is not rare in neonates and children with EVM. Many of the neonates (50%) and almost all of the children with EVM did not require prolonged hospitalization. Both normal CSF and PMN dominancy of CSF was common in neonates and children with EVM. Positive qualitative CRP of serum (up to two plus) was common especially in children with ...

Molecular detection and genotyping of enteroviruses from CSF samples of patients with suspected sepsis-like illness and/or aseptic meningitis from 2012 to 2015 in West Bank, Palestine

“…Infants with HEV sepsis-like illness and/or aseptic meningitis without CSF pleocytosis were identified in this study (60%). This high percentage of cases of HEV without pleocytosis is in congruence with other studies [ 24 , 25 ], but in contradiction with others [ 5 , 6 ]. This discrepancy could be due to different CSF pleocytosis definitions adopted and the age of the study samples.…”

Enteroviral meningitis in children: Clinical and laboratory features with and without pleocytosis

“…Enteroviruses are the most common pathogen of etiologicallyknown aseptic meningitis in children worldwide [1,[6][7][8]. Many previous studies have been conducted to evaluate the epidemiology of viral meningitis.…”

“…Aseptic meningitis caused by viruses is 20 times more common than bacterial meningitis [1]. Enteroviruses (EV) are responsible for 90 % of the etiologically known aseptic meningitis in infants [2].…”

“…When older children and adults are included, enteroviruses (EV) still rank first as the cause of more than 50 % of all cases [3]. It may not be statistically reported because of its usually mild and selflimiting clinical features and symptoms [1]. Enteroviruses can be detected in cerebrospinal fluid (CSF) by polymerase chain reaction (PCR).…”

“…Enteroviruses can be detected in cerebrospinal fluid (CSF) by polymerase chain reaction (PCR). Thus, the length of stay of the patients in the hospital is shortened, and the hospital costs, the frequency of inappropriate antibiotic use, and the frequency of healthcare-associated infections are reduced [1,4].…”